Wang Jiu-Yao, Liu Li-Fan
Division of Allergy and Clinical Immunology, Department of Pediatrics, College of Medicine, National Cheng Kung University Medical Center, Tainan 70428, Taiwan.
Asia Pac Allergy. 2012 Jul;2(3):167-71. doi: 10.5415/apallergy.2012.2.3.167. Epub 2012 Jul 25.
Asthma is an important health problem worldwide and the prevalence is increasing in most part of the world. The burden of this disease to governments, health-care systems, and patients and their families have been greater more than ever despite efforts advocated by Global Initiative for Asthma for total asthma controls. Using Taiwan National Health Insurance Research Database, in this review, the population-based prospective studies showed the costs and health care utilization of childhood asthma in Taiwan was 2 folds higher than non-asthmatic children, and the prescription patterns of anti-asthmatic medications among physician in different discipline were all far from satisfied. The appropriateness of combinational therapy of inhaled corticosteroids and long acting β-agonists for moderate to severe childhood asthma was only 62%. In a government-sponsored disease management program for asthmatic patients within national health insurance, though the total mean costs (26.5%) and outpatient costs (26.1%) increased, the mean emergency department visits and hospitalization rates were significantly reduced by 34.4% and 51.74%, respectively, compared to the previous year. Therefore, in the real-world situation, asthmatic patients as well as medical professions who take care of asthmatic children still have much space for their symptoms controls and knowledge improvement to reduce the burden of asthma. From the experience of care and management of childhood asthma in Taiwan may reveal same problems of childhood asthma care in the similar cultural and ecological environments of Asian pacific countries, and suggest government-sponsored program may also have significant impact aimed at improving the care of patients with asthma.
哮喘是一个全球性的重要健康问题,在世界大部分地区其患病率都在上升。尽管全球哮喘防治创议倡导全面控制哮喘,但这种疾病给政府、医疗保健系统以及患者及其家庭带来的负担比以往任何时候都更重。在本综述中,利用台湾国民健康保险研究数据库进行的基于人群的前瞻性研究表明,台湾儿童哮喘的成本和医疗保健利用率比非哮喘儿童高出两倍,不同学科医生的抗哮喘药物处方模式均远不能令人满意。吸入性糖皮质激素与长效β受体激动剂联合治疗中重度儿童哮喘的恰当性仅为62%。在一项政府资助的国民健康保险哮喘患者疾病管理项目中,尽管总平均成本(26.5%)和门诊成本(26.1%)有所增加,但与上一年相比,平均急诊就诊率和住院率分别显著降低了34.4%和51.74%。因此,在现实世界中,哮喘患者以及照顾哮喘儿童的医疗专业人员在症状控制和知识提升方面仍有很大空间,以减轻哮喘负担。从台湾儿童哮喘的护理和管理经验中,可能会揭示亚太国家在类似文化和生态环境下儿童哮喘护理中存在的相同问题,并表明政府资助的项目可能也会对改善哮喘患者护理产生重大影响。